Does staying neutral and impartial help MSF save lives?

Doctors Without Borders/Médecins Sans Frontières (MSF) gives emergency care to those most in need, no matter who they are; remaining neutral and impartial is essential to our work, but also often presents our front-line field workers with difficult choices.

A medical team carries out a vaccination campaign on both sides of an area divided by conflict. A doctor refuses a military commander’s demand that she treat his soldiers first. A hospital guard informs rebel and government fighters that both are welcome to seek care, but cannot enter the clinic with weapons or uniforms — and must wait their turn according to their needs, just like everyone else.

These are common occurrences in many of MSF’s operations around the world. MSF’s mission is to provide humanitarian emergency medical care to those who need it most as a result of violence, displacement, disaster or neglect. Our teams in the field provide lifesaving treatment to everyone who seeks our help, regardless of their identity, origin or religious affiliation. In conflict zones, we don’t choose sides, and we spare no effort to access those who would otherwise remain out of sight and out of reach due to persecution, fear or prejudice.

Neutrality and impartiality, along with independence, are among the most fundamental of MSF’s core humanitarian principles. In order to uphold them, our medical teams must avoid giving preferential treatment, even inadvertently, to any particular group or set of individuals, including (and often especially) to associates of government officials, armed officers or community leaders who claim authority or other privileges in particular areas.

The importance of remaining neutral and impartial to a humanitarian emergency medical organization is in many ways clear: Our purpose is to provide care to thosewho have no other access to urgent medical treatment. That means we can only prioritize our patients according to medical needs. The people who need our help the most are often those who already have no voice and no access to available medical resources. To truly be a doctor without borders is to go wherever the needs are greatest, regardless of any external pressures, interferences or boundaries.

Matteo Bianchi Fasani

Being neutral and impartial: Easier said than done

There are also practical reasons to be adamant about remaining neutral and impartial. Any perceptions that MSF is choosing sides will affect our abilities to reach the patients who need us most. People who see our medical staff as partners or agents of the ruling authorities may not seek urgently needed care for fear of continued persecution or worse. By acting only according to the imperatives of medical needs, we demonstrate our impartiality to communities in need of help, and build the trust needed to deliver care to those who need it most.

Remaining neutral and impartial, however, can be easier said than done. Most situations where MSF’s presence is needed are complex humanitarian crises in which very little is black or white. It is not always clear to our teams in the field how best to remain steadfast in our values — or what to do when our principles conflict with each other. Many of the places where MSF operates are controlled by armed groups or other parties to conflict or persecution. An MSF field team leader may stand on principle and refuse a local commander’s demands for preferential treatment. But what if that means we are then refused access to areas where people are urgently in need of medical care? Is it more important to be seen as independent or to save lives? What if compromising on one principle to save more lives in turn puts others at risk somewhere else?

There are not always easy answers to the dilemmas our field workers must face. In every instance, we must make the best choices we can, and do so as transparently as possible. This can only happen when we don’t simply state our values, but seek to continually renew our understanding of them, so that we can apply them as well as possible in every situation we face.

MSF’s commitment to neutrality and impartiality is upheld in part by international humanitarian law, under which all combatant forces in conflict zones must allow medical workers access to civilians on both sides of the front lines. But more than anything it is made possible by the support we receive from private individuals and donors around the world, who also give us the independence necessary to only intervene where and when we feel our presence is most needed, regardless of any political, financial or other calculations.

Whenever there is conflict and violence, it is often the vulnerable who suffer most. By refusing to give preference to anyone except those in greatest need, MSF seeks to alleviate that suffering, and to deliver hope and care to those who would otherwise have none.